(1) The stage of development.

(2) The climax.

(3) The stage of healing.

During the stage of development, which usually lasts about a week, the symptoms of the disease rapidly increase.  The patient gets extremely weak and faint, has severe headaches and absolutely no appetite.  In consequence of the high fever, he complains of thirst; the skin is dry, the lips chapped, the tongue coated; the pulse is rapid and full; the bowels are constipated, but the abdomen is practically not inflated nor sensitive to pressure.  In most cases the spleen is evidently enlarged.

Before the end of the first week the climax is reached.  This in the lighter cases lasts for the second week, or in more severe cases, even until the third.  The fever is constantly high, even 104 deg. and over.  The body is generally benumbed, the patient becomes delirious at night or lies absolutely indifferent to all surroundings.  The abdomen is now inflated, the buttocks show small, light red spots,—­the so-called “roseola,”—­which are characteristic of abdominal typhus.  Furthermore, in most cases, bronchial catarrh of a more or less severe nature appears.  Instead of obstruction of the bowels there is diarrhoea—­about two to six light yellow thin stools, occur within 24 hours.  During this second stage the complications appear.

At the end of the second or the third week respectively, the fever slackens; in cases which take a favourable turn, the patient becomes less benumbed and less indifferent, his sleep is quieter; appetite gradually returns.  The bronchial catarrh grows better, the stool once more becomes normal; in short, the patient enters the stage of convalescence.

This is a short sketch of the course the illness usually takes.

Of the deviations and complaints accompanying Abdominal Typhus, the following are the most important details:—­

The fever takes its course in strict accordance with the described anatomical changes in the intestines.  It increases gradually during the first week, and at the end of that period it reaches its maximum of about 104 deg..  It stays at that point during the second stage, gradually sinking during the third stage.

In lighter cases the second stage may be extraordinarily short.

If perforation of the intestines, heavier bleeding or general collapse should ensue, attention is directed thereto through sudden and considerable decrease in the temperature of the body.  Pneumonia, inflammation of the inner ear and other accompanying complications also cause sudden access of fever.

Effect upon the digestive organs:  The tongue is generally coated while the fever lasts; the lips are dry and chapped, and look brown from bleeding.  If the patient is not carefully attended to during the extreme numbness, a fungus growth appears which forms a white coating over the tongue, the cavity of the mouth and the pharynx, and may extend into the oesophagus.  Later on the tongue loses this coating and becomes red as before.  Few symptoms are shown by the stomach, except occasional vomiting and lack of appetite.  During convalescence there is great desire for food.  The anatomical changes in the intestines have already been mentioned.